PAPS PapersImpact of newly adopted guidelines for management of children with isolated skull fracture
Section snippets
Methods
Patients treated at our pediatric level I trauma center between February 9, 2012 and February 8, 2014 with a skull fracture identified using computed tomography were considered for study inclusion. Patients were screened and enrolled at the time of their treatment by a member of the study team, or identified after discharge using hospital information systems and ICD9 diagnoses codes. In either case, patients with a Glasgow coma score of 15 on arrival were considered eligible for enrollment,
Results
Eighty-eight patients met eligibility criteria for inclusion in the study. This represents 14% of all patients with a skull fracture, and 1.7% of all patients with any head injury treated at our hospital over the study period. Patient and injury characteristics are summarized in Table 2. The median age was 10 months (range: 18 days to 16 years). Fractures of the parietal bone were the most common type of fracture (56; 64%), and 15% of patients had fracture of more than one skull bone. Falls
Discussion
Though controversial, skull fracture is often considered a predictor of intracranial pathology in children presenting to emergency departments with minor head trauma [6], [8], [9], [10], [11], [12]. However, in children with ISF presenting with normal mental status and no intracranial pathology on initial radiologic evaluation, complications requiring specialized treatment are rare [3], [4], [5], [6]. Despite this, the majority of patients with ISF of the skull vault are hospitalized for
Conclusion
Implementation of a clinical treatment algorithm for the management of children with an ISF and normal neurologic exam on initial evaluation reduced admissions without compromising patient safety. Young age of the patient remains a common concern for practitioners when considering discharge. Our study also suggests that interhospital transfer may be unnecessary in many cases.
Acknowledgments
Center for Clinical and Translational Sciences grant support (CTSA 5UL1RR025764-02).
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2019, Facial Trauma Surgery: From Primary Repair to ReconstructionA Systematic Review and Meta-Analysis of the Management and Outcomes of Isolated Skull Fractures in Children
2018, Annals of Emergency MedicineCitation Excerpt :After screening title and abstracts for each of these, we identified 69 studies for full-text review. After a manual review, 21 studies were identified that met our final inclusion criteria.4-6,16-33 We describe the study designs and patient characteristics for each of the included studies (Table 1).
Soft-tissue evidence of head injury in infants and young children: is CT head examination justified?
2017, Clinical RadiologyCitation Excerpt :Therefore, there is a service provision and economic impact for the hospital following the identification of simple skull fractures in infants and young children. Metzger et al.,12 implemented guidelines designed to reduce admission of children with simple skull fracture following blunt head trauma and reduced admission rates from 75% to 57% in their study in Salt Lake City, UT. Metzger et al. also noted that young age combined with the presence of skull fracture was a concerning feature for clinicians and that this often prompted hospital admission despite this not being indicated by their guidelines.
Observation for isolated traumatic skull fractures in the pediatric population: Unnecessary and costly
2016, Journal of Pediatric SurgeryCitation Excerpt :Although data supports early discharge from the emergency department in this patient population, there is a lack of published data guiding the management of this patient population. Our study found that the minority of our patients were directly released from the ED with follow up with their primary care physicians (22.5%) and that the majority (77.5%) were admitted for serial neurological examinations, despite evidence that these patients are at low risk for complication [14–19]. Our admission rate correlates with that of other studies looking at isolated skull fractures, in which 75-78% of the patients were hospitalized [14,17].